Advancing Modules Archives - Page 80 of 135

Learning points

Having completed this module the learner should know about:

Clinical research

- Asking and answering questions to improve stroke care
- Different types of studies for different types of questions
- Randomised Controlled Trials (RCTs) being the best for determining whether a treatment works or not

Evidence

- Synthesising the results of relevant research
- The Cochrane Library

Evidence based guidelines

- How evidence based guidelines are developed and know about levels of evidence

Clinical standards

- The seven national stroke standards
- The target for stroke unit admission

Clinical audit

- The Scottish Stroke Care Audit (SSCA) and how to access reports
- Interpreting the reports on performance

Service improvement

- The Managed Clinical Network (MCN) and its role in quality improvement
- How audit data can be used to drive improvements
- Priorities from Better Heart Disease and Stroke Care Action Plan
- Local action plans including training and education

High quality care for all

- Delivering quality care to all patients in line with standards/guidelines
- The individual’s contribution to improving the quality of stroke services
- Raising unanswered questions and facilitating research

Introduction

The purpose of this module is to:

Ensure that health professionals understand evidence based practice.
Provide the health professional with an overview of the systems in place to improve care for stroke patients in Scotland.
Enable the health professional to understand their role in context, and participate actively in improving patient care.

The module consists of 4 case scenarios and we would recommend that you work through the topic loops provided within the cases which provide additional background information. The module test will include questions on the information provided in the topic loops.

Module Authors

Module lead

Prof Peter Langhorne, Professor of Stroke Care, University of Glasgow

Group members

Katrina McCormick, eLearning & Health Information Manager, Chest Heart & Stroke Scotland
Prof Martin Dennis, Professor of Stroke Medicine, University of Edinburgh
Serena Battistoni, eLearning Interactive Content Developer, Chest Heart & Stroke Scotland

Module Reviewer

Akila Visvanathan, Medicine of the Elderly and Stroke Registrar, NHS Lothian

This module was originally developed by:

Module lead: Prof Peter Langhorne, Professor of Stroke Care, University of Glasgow

Group members: Katrina Brennan, National MCN Coordinator, NHS Lanarkshire
Prof Martin Dennis, Professor of Stroke Medicine, University of Edinburgh
Hazel Dodds, Clinical Coordinator, NHS National Services Scotland
Claire McFarlane, Network Manager, Scottish Stroke Research Network
Alex Pollock, Research Fellow, NMAHP Research Unit, Glasgow Caledonian University

Critical readers: Dr Mark Barber, Consultant Physician, NHS Lanarkshire
Fiona Coupar, Occupational Therapist, NHS Greater Glasgow and Clyde
Hazel Hamilton, Stroke Coordinator, NHS Highland
Prof Anthony Rudd, Professor of Stroke Medicine, Guy’s and St Thomas’ Foundation Trust
Dr Lisa Salisbury, Research Investigator, University of Edinburgh
Dr Elizabeth Tolmie, BHF Lecturer in Cardiovascular Care, University of Glasgow

11: Service Improvement

Introduction

On completion of this module you should have a critical understanding of how clinical research and service improvements are used to provide high quality stroke care.

The answers to all the test questions are contained within the module. This information may be provided in the ‘Additional Information’ boxes and topic loops on some of the pages.

Topic Loops

Recurring topics in this subject are listed below as topic loops. These are short tutorials explaining key concepts. When working through the cases links to these topic loops will appear underneath the main content of the page.

Conclusion

Having completed this module you will have learned via the 4 patient scenarios about driving, vocational rehabilitation, leisure, and sexuality.

Specifically you will have considered:

The effects a stroke may have on a person’s ability to return to work and how to advise a person on return to work issues and who to refer to for more specialised assessment and advice.
The impact of stroke on a person’s ability to resume normal sexual activity and intimate relationships, what advice to them and where to access more specialised advice if necessary.
The effects a stroke may have on a person’s ability to return to driving including the legal aspects and regulations around resuming driving after a stroke, and how to refer someone for specialised advice and assessment of driving abilities.
The effects of stroke on a person’s ability to resume leisure pursuits after stroke and the management and options available for resumption of leisure activities.

Leisure: Further reading

Parker CJ, Gladman JRF, Drummond AER. The role of leisure in stroke rehabilitation. Disabil rehabil 1997; 19: 1-5
Suto M. Leisure in Occupational Therapy. Canadian Journal of Occupational Therapy. 1998. 65 (5) 271-278
Tae Im Yi et al (2015) Participation in Leisure activity and exercise of chronic stroke survivors using community based rehabilitation services in Seongham City. Ann Rehabil med Apr; 39(2): 234-242
An exploration of participation in leisure activities post-stroke, (2010), Australian Occupational Therapy Journal 57(3):159-66
Jongbloed, L. & Morgan, D. (1991). An investigation of involvement in leisure activities after a stroke. American Journal of Occupational Therapy, 45 (5), 420–427

Leisure: Key messages

Following a stroke people are known to have markedly reduced levels of leisure participation.
Leisure activities are important for our physical, psychological and social well-being.
Leisure activities are an important part of rehabilitation and recovery.
Following a stroke people can access mainstream leisure facilities with support and adaptations as required.
A range of classes and activities may be available for those with long term conditions including stroke.
Advice about holidays and travel following stroke is available from various sources.

Leisure: Outcome

A picture of Mr McGuire and his wife on a beach holiday, they look happy.

Congratulations. With your help Mr McGuire has been able to return to his hobbies with his friends and wife.

He has booked a holiday to Gran Canaria. He goes swimming with his friend once a week. He uses a hoist to access the pool and floats to help him swim, both of which are available to uses free of charge at the leisure centre. He is able to assist his wife with some light gardening tasks such a potting plants and hoeing, using adapted gardening equipment recommended by the Occupational Therapist.

He is no longer feeling isolated and proudly tells you that he has lost weight. He is using his left arm more through swimming and feels that the function is improving. Mrs McGuire tells you that his mood and levels of fatigue have improved and that he is much happier and feeling more confident in his abilities these days. He is feeling more positive about his future.

Leisure: What can help – return to holidays and travelling

A picture of Mr McGuire, he's thinking about a holiday Prior to his stroke, Mr McGuire was a keen traveller. He would like to plan a city break away with Mrs McGuire and later in the year also wishes to return to Gran Canaria where they have holidayed for the past 10 years.

The couple are concerned about the risks of flying and are keen to know more about travel options available to them.

To find out more about insurance requirements, adapted accommodation and organisations who can advise:

Leisure: What can help – return to gardening

Mr McGuire finds it difficult to get down on his knees to garden and has weakness in his left arm. You discuss some of the aids and adaptations which might help him which includes:-

adapting the task – working in raised beds to remove the issue of reaching to ground level
Trialling the use of different garden tools which may compensate for loss of upper limb function